Published on

It isn’t news that patients sometimes receive bills that seem out of proportion to the care they received in an emergency setting (especially a freestanding emergency rooms)—and that the media and state legislatures have taken notice. A new statewide survey in New Mexico reveals that nearly a third of patients say they received large “surprise bills” after seeing clinicians outside their insurer’s network. In addition, data from the Consumer Federation of America and the North American Consumer Protection Investigators shows that “health products/services” (which includes medical billing issues) are the sixth most-mentioned complaint among American consumers. The latest is that a new study by the National Bureau of Economic Research quantifies this phenomenon, also finding that outsourcing ED staffing dramatically increases the likelihood that patients who visit an in-network facility will be treated (and billed) by out-of-network providers. In Surprise! Out-of-Network Billing for Emergency Care in the United States, authors Zack Cooper, Fiona Scott Morton, and Nathan Shekita report that in 22% of emergency episodes, patients were treated in in-network hospitals by out-of-network physicians. In their study of claims coming out of Newport Hospital and Health Services, near Spokane, WA, they found that billing for the “most complex” level of care jumped 22% after a company called EmCare started staffing and providing administrative support for the ED. That matches up exactly with the proportion of emergency visits in which in-network patients were seen by out-of-network providers. The authors also say that a New York law that paves the way for binding arbitration between physicians and insurers to settle “surprise bills” reduced out-of-network billing rates. The lesson for urgent care operators is to make sure your billing and payment policies are as clear as they can be. Urgent care has continued to surge as a consumer choice because patients perceive they’re getting good care at a fair price. Continuing to engender goodwill based on those principles will help cement the differences between this setting and others for patients.

Surprise Bills Continue to Anger Patients—and One Company’s Name Keeps Turning Up